Health equity

What is health equity?

Significant and persistent inequalities in health exist across population groups and communities in Canada. Such inequalities are  noted by differences in

  • life span
  • self- reported health
  • rates of disease.

Some of these variations are based in genetics or lifestyle factors, but most differences in health are related to socioeconomic inequality.

The lower you are on the socioeconomic scale, the poorer your health. This is called the health gradient.

Remaining life expectancy and health-adjusted life expectancy at age 25, by income decile, men, Canada, 1991-2001

(Source: Remaining life expectancy and health-adjusted life expectancy at age 25, by income decile, men, Canada, 1991-2001)

In Canada, there is a growing gap between the richest and poorest Canadians. This gap matters:  the more unevenly wealth is distributed, the more the health of the entire population suffers.

In Canada, there is a growing gap between the richest and poorest Canadians. This gap matters:  the more unevenly wealth is distributed, the more the health of the entire population suffers.

(Source: The Spirit Level, Richard Wilkinson and Kate Pickett, 2009)

Which groups face the greatest health inequities?

In Ontario, groups facing disproportionate social and health inequities include:

  • Aboriginal communities
  • People of colour (newcomers to Canada as well as long term Canadian residents and citizens)
  • Rural communities
  • Women

Intersecting factors include such things as disability, immigration status or sexual orientation.

How is equity related to health promotion?

The 1986 Ottawa Charter for Health Promotion  names equity as a prerequisite for health, together with social justice

Through the lens of health equity, health promoters have a more nuanced recognition of how the key determinants of health affect different groups, and how policies and programs can reduce inequities.  Because most inequities are socially created, rather than the result of individual choices we make, remedies need to address social factors. 

In Canada, we need to use a health equity lens to develop effective remedies. Health promoters must ask critical questions informed by health equity at each stage of their work – policy and strategy, designing actions and programs, and implementation and evaluation – so that health can be improved for everyone.

Planning for health equity

Health equity is more than equality of access to services. It also means equality of opportunity for:

  • education
  • employment
  • housing
  • food security

It means inclusion for all. Most importantly, it means improved health for everyone.

Because health can vary across different regions and within groups in the same community, we must understand and address needs at various levels:

  • large populations
  • sub-populations
  • communities
  • individuals

To achieve health equity, we must combine broad population level approaches with more targeted interventions.

We need data on sub-populations (including race, language, ethnicity, region and neighbourhood) so we can develop appropriate targeted interventions.

It can be difficult to predict how any given program will affect health equity. Assessment tools may help health promoters anticipate likely outcomes at the planning stage itself. Known as Health Equity Impact Assessments, Health Equity Audits, or Health in all Policies, these approaches use health equity analysis to understand how a particular policy or program will influence the distribution of improved health throughout a given population. Such initiatives are relatively recent in Canada, although they have been in use in the UK, Europe, Australia and New Zealand for some time.

Health Nexus is a ‘Champion Organization’ for the Ontario Ministry of Health and Long-term Care’s Health Equity Impact Assessment Tool

Where can you go for more information?

Health Nexus Resources

Health equity and racialized groups: a literature review


This literature review provides evidence from the literature on how to embed health equity into organizational capacity. The discussion section provides health promoters and health promotion organizations with evidence to serve as a foundation for tangible health equity activities.

Health equity and racialized groups: a literature review

Health Equity and Racialized Groups: A Literature Review (692kB PDF, 2011)
This Review presents a framework for understanding and action on racialized health disparities.

Addressing health inequities for racialized communities: a resource guide

Addressing Health Inequalities for Racialized Communities: A Resource Guide (716kB PDF, 2011)
A tool to support those who are engaged in health promotion to reduce racialized health inequities

Primer to Action: Social Determinants of Health. (PDF 954kB, 2008) Toronto, Health Nexus and Ontario Chronic Disease Prevention Alliance. A resource to understand how the Social Determinants of Health impact chronic disease.

Are Widening Income Inequalities Making Canada Less Healthy? Executive Summary (PDF 213KB, 2002) and Full Report (PDF 3.7MB, 2002)  Health Determinants Partnership.
This report explains  why Canadians cannot afford to be complacent about the growing  income gap in our society.

Other resources